The objective of this study is to examine and measure the extent of income-related horizontal inequity (unequal use of healthcare services for equal medical need) among the Indigenous Australians. This study also aims to understand the role of different socioeconomic factors in explaining the degree and direction of inequity

Hall, Jane

Pulok, Mohammad Habibullah

van Gool, Kees

English

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Horizontal inequity in healthcare utilisation  within the Indigenous Australians1Mohammad Pulok, Kees van Gool and Jane HallEmerging Health Policy Research Conference University of Sydney, 26 July 2018Background Twin principles of Medicare in Australia:  Equity in access to healthcare services : according to need  Equity in health care financing: payment according to ability Equity goal in healthcare access distinguishes between:  Horizontal equity – equal treatment of equals Vertical equity – appropriate unequal treatment of unequals2 Horizontal inequity in healthcare: Economic approach-unequal use of healthcare services for equal medical need  regardless of socioeconomic status (SES) Indigenous Australians: Most disadvantaged communityHigher disease burden but lower access to health servicesHigher hospitalisation but lower surgical proceduresLower use of Medicare funded specialist services  Closing the gap : Higher use of Medicare funded GP servicesAverage improvement might mask within inequality and inequity3Does inequity follow the similar pattern within Indigenous Australians? Background Horizontal inequity (HI) approach:  3 steps1. Identification  and need-standardisation: Regression analysis2. Measurement : Concentration curve (CC) & Concentration index (CI) of need-adjusted use4MethodHI>0 : Pro-rich inequity HI<0 : Pro-poor inequity3. Explanation : The decomposition approach5Data and variables Data: Australian Aboriginal and Torres Strait Islander Health Survey   (AATSIHS) of 2012-13Sample : 2823 adult individuals from non-remote area Probability of healthcare use: Any visit, GP visit &  specialist visit in last 2 weeksInpatient admission in last 12 monthsNeed indicators: Age, gender, SAH, mental health, disability status & diabetesRanking (non-need) variable:  Household incomeNon-need indicators: Private health insurance, concession card, employment  & education Need variables: Weak association of gender, age SAH with specialist visit6Results  Any visit GP visit Specialist visit Inpatient admission1  Odds ratio 95% CI Odds ratio 95% CI Odds ratio 95% CI Odds ratio 95% CI Household Income: Decile 1 Reference Reference Reference Reference Decile 5 1.59** (1.11 - 2.26) 1.24 (0.84 - 1.83) 1.04 (0.46 - 2.35) 0.88 (0.57 - 1.35)Decile 6 1.62** (1.10 - 2.39) 1.01 (0.66 - 1.55) 2.64*** (1.29 - 5.39) 1.16 (0.74 - 1.83)Decile 7 1.17 (0.77 - 1.78) 0.95 (0.60 - 1.52) 2.11* (0.95 - 4.66) 0.94 (0.56 - 1.56)Decile 8 1.16 (0.75 - 1.80) 0.82 (0.49 - 1.36) 1.68 (0.74 - 3.82) 1.42 (0.87 - 2.31)Decile 9 1.82** (1.12 - 2.97) 1.04 (0.60 - 1.80) 2.70** (1.13 - 6.48) 1.57 (0.89 - 2.77)Decile 10 1.47 (0.82 - 2.65) 1.20 (0.64 - 2.26) 2.96** (1.13 - 7.77) 1.44 (0.74 - 2.80)Private health insurance  1.69*** (1.34 - 2.14) 1.38** (1.07 - 1.78) 2.14*** (1.38 - 3.31) 1.03 (0.78 - 1.36)Concession card  1.33** (1.03 - 1.70) 1.12 (0.85 - 1.46) 1.25 (0.74 - 2.12) 1.13 (0.84 - 1.51)Education: Year 12 or above Reference Reference Reference Reference Education: Year 9-11 0.85 (0.69 - 1.04) 0.88 (0.70 - 1.10) 0.68** (0.46 - 1.00) 0.91 (0.72 - 1.14)Education: Year 8 or below 0.72** (0.52 - 0.98) 0.81 (0.58 - 1.13) 0.52** (0.29 - 0.94) 0.73* (0.51 - 1.05)Education: Never attended 0.57 (0.21 - 1.52) 0.88 (0.33 - 2.30) 0.27 (0.03 - 2.41) 1.74 (0.67 - 4.50) Regression analysis Non-need variables Results 70.05.1.15Proportion1 2 3 4 5Quintile distribution of specialist visitActual Predicted Standardised0.2.4.6.81cumulative share of specialist visit0 .2 .4 .6 .8 1cumulative share of individuals(poorest to richest)ActualNeed predictedNeed standardisedline of equalityConcentration curves Inequity: Specialist visit Pro-rich HI: 0.016***Results 8 Explaining inequity in specialist visit 9-Improve access to specialist care for low income people-Incentive for more bulk-billing specialist services-Strengthening and reforming Medicare safety netPolicy implications Thank You

Horizontal inequity in healthcare utilisation within the Indigenous Australians

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Horizontal inequity in healthcare utilisation within the Indigenous Australians

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